Cancer chemotherapy is associated with side effects that can produce symptoms that impact quality of life and impair functioning. Many individuals experience multiple symptoms during a course of chemotherapy. While there have been advances in treating symptoms and a growing body of evidence- based symptom guidelines, effective symptom relief is often elusive. A variety of reasons account for this including inadequate communication between patients and their health care providers, difficulty in following ambulatory patients who are at home, inadequate application of the evidence base to treat symptoms, and health care providers beliefs about subjective patient complaints and beliefs about the efficacy of current symptom treatment approaches. In addition, poor communication and documentation practices among health care providers about the patient's symptom experiences often interferes with continuity and tracking unrelieved symptoms to resolution. Coupling the use of technology with a responsive health care provider such as an oncology nurse practitioner who applies current best evidence to treat symptoms, provides an opportunity to overcome barriers, improve symptom relief and subsequently improve functioning in individuals receiving chemotherapy for cancer. This prospective, clinical trial proposes to test a daily automated system know as Telephone Linked Care (TLC-NP) for monitoring symptoms for patients living at home during chemotherapy treatment. The monitoring system is paired with automated delivery of self-care suggestions tailored to the patient's specific symptom profile. TLC also automatically emails 'alerts'to the study oncology nurse practitioner about unrelieved symptoms. The nurse practitioner, utilizing national evidence based symptom guidelines intervenes for unrelieved symptoms. Integration of the system is further enhanced through documentation of assessments and interventions incorporated seamlessly into the electronic medical record so that the entire oncology treatment team has access to the patient's progress.
The specific aims of the study are to test whether the TLC-NP intervention reduces severity and distress of 12 symptoms, improves functional performance and decreases interference with activity when compared with a usual care group.
Other aims will compare self care strategies utilized and their perceived effectiveness, document satisfaction with the TLC system, explore impact on work productivity and absenteeism and conduct a cost-benefit analysis. The sample will consist of 280 adult participants initiating a course of chemotherapy who will be randomly assigned to the experimental condition, TLC-NP, the integrated management system with nurse practitioner support or to usual care which includes daily symptom documentation utilizing the TLC system but without TLC self-care instructions or interface with the nurse practitioner. Participants in the usual care group are instructed to interact in their usual manner with their heath care team for symptom concerns. Participants will call TLC daily and report symptoms for the previous 24 hours for a course of chemotherapy.